Prepared By:

Guerly Manzano-Acosta,MAN
Skills Lab Instructor
What are Leopold Maneuvers?

 Leopold maneuvers are a systematic four-

step physical examination performed to
evaluate the fetal lie, presentation, attitude,
and position of the fetus in the uterus.
Purpose of Leopold Maneuver
Purpose of Leopold Maneuver
The purpose of Leopold
maneuvers are to determine:
 Fetal presentation
 Fetal lie
 Fetal position
 Fetal attitude
 No. of fetuses
 EQUIPMENT

 Examination table
 Rolled Towel
 Top Sheet linen
 Pillow
 Basin and warm water (for
hand washing)
 NURSING CONSIDERATIONS
1. Patient should empty her bladder
2. Examiner’s hand should be warm
3. Explain the procedure to the patient
4. Provide privacy
5. Position patient in dorsal recumbent.
6. Gentle yet firm touch
 IMPLEMENTATION

1. Prepare the client

 Explain the procedure

2. Instruct the client to empty her bladder.

3. Position the woman supine with knees

slightly flexed. Place a small pillow or rolled
towel under one side.

4. Wash your hands using warm water.

5. Observe the woman’s abdomen for

longest diameter and where fetal
movement is apparent
 “What fetal part (i.e., head or
buttocks) occupies the
fundus (i.e., top of the
uterus)?“
 Purpose of the first
maneuver is to
determine fetal presentation,

fetal lie, and fundal height .

PROCEDURE
• Stand client’s right side facing her
• Warm both the hands
• Place both the hands over the fundal
area
• Then, palpate from one hand while
applying steady firm pressure with
the other hand to make it easier to
identify fetal parts
 Findings
• If you feel soft, irregular soft ,
immovable mass, it indicates fetal
buttocks is in the fundus.
• If you feel hard , round mass
which is ballotable, it indicates
that the fundus occupies the fetal
head.
• If you feel the upper pole is
empty, indicates a transverse lie.
 FUNDAL HEIGHT
“On which
maternal
side does the fetal
back is located?”
Purpose: To
determine where
the fetal back is
facing and the
position (i.e., ROA,
LOA, etc)
 PROCEDURE
• Stand facing the client.
• Place both hands on either side of the
abdomen between flanks and
umbilicus.
• Then, while steadily supporting with
the right hand, palpate with the left
hand. Palpate using deep gentle
pressure in slightly circular motion – It
will helps to easily identify the fetal
parts.
• Repeat the steps on the other side as
well using opposite hands
 FINDINGS
1.If you feel continuous smooth
structure indicates its fetal back.
2. If you feel irregular multiple
knoblike structures indicates its
fetal limbs
3. If the lie is transverse, head or
breech may be palpable from one
of the sides of maternal torso.
 This maneuver
confirms fetal
presentation
and determines
its engagement
(mobility).
 “What is the
presenting part? Is
it engaged?“
PROCEDURE
• Stand facing the client.
• Your right hand – thumb on
one side and four fingers on
the other side, grasp the lower
pole of the uterus just above
the symphysis pubis. Use your
left hand to grasp the fundus
at the same time.
• Then, try to move presenting
fetal part between your thumb
and four fingers.
FINDINGS:

• If the presenting part moves upward so

an examiner’s hands can be pressed
together, the presenting part is not
engaged (not firmly settled into the
pelvis). If the part is firm, it is the head; if
soft, and then it is breech.
• If the lie is transverse, like the empty fundus, the
lower pole of the uterus will also be empty.
Hence no fetal parts will be palpable.
 This maneuver
determines fetal
attitude and
degree of fetal
extension into
the pelvis.

 Should only be
done if fetus is
in cephalic
presentation.
FETAL ATTITUDE
 PROCEDURE
• In this step, stand facing towards client’s feet.
• Place hands below the umbilicus, parallel to
inguinal, and walk fingers around presenting
part towards the midline and symphysis pubis.
Nurse caution!

 Contraindication  Complications
Leopold maneuvers  It may cause mild discomfort
should not be to the mother especially during
performed during the third maneuver.
uterine  And some very rare cases, it
contractions. may trigger uterine
contractions.